Provider Demographics
NPI:1801879051
Name:DAVE, MALTI (MD)
Entity type:Individual
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First Name:MALTI
Middle Name:
Last Name:DAVE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0209
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:11605 STUDT AVE STE 120
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7052
Practice Address - Country:US
Practice Address - Phone:314-432-7426
Practice Address - Fax:314-432-7247
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2018-04-12
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Provider Licenses
StateLicense IDTaxonomies
MO112797207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG5166Medicare UPIN